The incidence of suicide in University students in England and Wales 2000/2001-2016/2017: Record linkage study

A qualitative study exploring participants experiences of the Mental Imagery for Suicidality in Students Trial

OBJECTIVES

Higher education students experience elevated levels of suicidal ideation, but often face barriers in accessing support. The Mental Imagery for Suicidality in Students Trial (MISST; ISRCTN13621293; NCT05296538) tested the feasibility and acceptability of a six-session imagery-based approach called Broad-Minded Affective Coping (BMAC). This qualitative evaluation explored the experiences of MISST participants and staff.

DESIGN

A qualitative study using one-to-one qualitative interviews with participants and staff recruited from MISST. Reflexive thematic analysis was used to explore trial participant and staff experiences to inform a future definitive trial.

METHODS

Student participants (n = 16), research assistants (n = 4) and the trial therapist (n = 1) were interviewed and transcripts analysed using reflexive thematic analysis.

RESULTS

Four key themes were identified. The first theme highlights the value and challenges for students in talking about suicide. The ways in which communication and rapport can be built to facilitate this conversation are explored in theme 2. Theme 3 explains how working with the BMAC therapist increased participants' awareness of their current mood, drew their attention to positive moments in their lives and helped them to actively recall these moments to interrupt negative cycles of rumination and suicidal ideation. The extent to which the BMAC is 'fit for purpose' is outlined in theme 4, generating specific recommendations for future intervention development.

CONCLUSIONS

The BMAC offers a positive, time-limited, structured intervention that is well suited to meet the needs of higher education students experiencing suicidal ideation. Further research is needed to test the effectiveness on mental health and suicide-related outcomes.

Suicidal thoughts and behaviours among student nurses and midwives: A systematic review

AIM

To synthesize research investigating suicide, suicide attempts, self-harm and suicide ideation in nursing and midwifery students, a group of interest due to high rates of suicide among qualified nurses. Specific areas of interest for this review included prevalence, factors which may contribute to or mitigate risk and suicide prevention interventions.

DESIGN

A systematic review was conducted, and Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed.

DATA SOURCES

Three electronic databases were searched, and additional articles identified using hand-searching. Studies were included if they examined suicide, suicide attempts, self-harm or suicide ideation in nursing or midwifery students.

REVIEW METHODS

Studies were deduplicated and assessed for inclusion. Data from included studies were extracted, quality of studies assessed and data synthesized, informed by study focus, design and assessed quality.

RESULTS

About 46 studies of largely moderate to low quality were identified. A high-quality study demonstrated increased risk of suicide in Swedish female nursing students, and increased risk of self-harm in nursing students of both sexes. Prevalence of suicide ideation did not appear to differ across course year, or between nursing students and students on other programmes. Psychiatric conditions, particularly depression, were associated with suicide ideation. Three studies related to suicide prevention interventions were identified. Integration of wellness initiatives into the curriculum and peer support were preferred interventions among nursing students and teaching staff.

CONCLUSIONS

To understand the extent of suicide and self-harm among nursing and midwifery students there is a need for further epidemiological research stratified by programme of study. To develop prevention interventions and initiatives for nursing students, high-quality longitudinal studies should examine characteristics associated with suicide and self-harm.

IMPACT

Current findings suggest interventions could include support for students experiencing mental health difficulties, foster peer support, and help develop wellness. No patient or public contribution.

Outcomes for university students following emergency care presentation for deliberate self-harm: a retrospective observational study of emergency departments in England for 2017/2018

OBJECTIVES

Identify university-aged students and contrast their healthcare provision and outcomes with other patients in the same age group attending emergency departments for deliberate self-harm.

DESIGN

Retrospective cross-sectional observational study.

SETTING

Patients visiting 129 public hospital emergency departments across England between April 2017 and March 2018.

PARTICIPANTS

14 074 patients aged 18-23 visiting emergency departments for conditions linked to deliberate self-harm, 1016 of which were identified as university-aged students.

OUTCOME MEASURES

We study various outcomes across the entire patient pathway in the emergency department: waiting time to initial assessment on arrival at the emergency department, count of investigations delivered, discharge destination (patients refusing treatment or leave before being seen, referred to another provider or admitted to inpatient care, discharged with no follow-up) and unplanned follow-up visit within 7 days.

RESULTS

We find a statistically significant difference of 0.262 (-0.491 to -0.0327) less investigations delivered to students compared with non-students (about 8% compared with the baseline number of investigations for non-students). Stratified analyses reveal that this difference is concentrated among students visiting the emergency department outside of regular working hours (-0.485 (-0.850 to -0.120)) and students visiting for repeated deliberate self-harm episodes (-0.881 (-1.510 to -0.252)). Unplanned reattendance within 7 days is lower among students visiting emergency departments during out of hours (-0.0306 (-0.0576 to -0.00363)), while students arriving by ambulance are less likely to be referred to another provider (-0.0708 (-0.140 to -0.00182)) compared with non-students.

CONCLUSIONS

We find evidence of less-intense investigations being delivered to patients aged 18-23 identified as students compared with non-students visiting emergency departments after an episode of deliberate self-harm. Given the high risk of suicide attempts after episodes of deliberate self-harm among students, our findings may highlight the need for more focused interventions on this group of patients.

Suicidal behaviour among the university students in the UK: A systematic review

Introduction

Identifying risk factors would help consider suicide prevention in any specific population. We aimed to assess suicidal behaviour among university students in the UK.

Methods

An extensive keyword search was conducted through PubMed, Cochrane, CINHAL Plus, PubMed Central, Web of Science, Trip database, and Science Direct, following the PRISMA guidelines to identify different publications. The search strategy for the literature review was based on the Population Exposure Outcome framework. Critical appraisal utilised the CASP tool for cohort studies and the AXIS tool for cross-sectional studies, resulting in 14 included studies. A narrative synthesis was performed.

Results

Postgraduate and undergraduate students used different suicidal methods such as poisoning, jumping, hanging, drowning, and suffocating, with jumping most preferred by male students. The predisposing factors of suicide among university students included: mental health problems (depression, psychological stress, psychosis, mania, neuroticism, financial anxiety, imperfect parents' connection with students), sexual orientation with risk of suicide among non-heterosexual students due to lowered self-esteem from feeling disregarded, disrespected and insufficient attention from the surrounding. Suicidal behaviour was high among unmarried students, male and unemployed female students, and students with childhood experiences such as physical abuse, family violence, emotional abuse, neglect, and physical punishment-gender, with females seeking more services from general hospitals with more suicide attempts in older females. High risk was also noted in males, with increased risk in white students compared to black students.

Conclusion

The review highlighted that students with previous mental health problems, a history of experiencing sexual abuse in childhood, bad relationships with their mother, disrespect and disregard in the community due to sexual identity are the major contributing factors for suicide among university students in the UK.

Prevalence of Suicidal Behavior Among Students in South-East Asia: A Systematic Review and Meta-Analysis

OBJECTIVES

Estimation of rates of suicidal behaviors (ideation, plan, and attempt) would help to understand the burden and prioritize prevention strategies. However, no attempt to assess suicidal behavior among students was identified in South-East Asia (SEA). We aimed to assess the prevalence of suicidal behavior (ideation, plan, and attempt) among students in SEA.

METHODS

We followed PRISMA 2020 guidelines and registered the protocol in PROSPERO (CRD42022353438). We searched in Medline, Embase, and PsycINFO and performed meta-analyses to pool the lifetime, 1-year, and point prevalence rates for suicidal ideation, plans, and attempts. We considered the duration of a month for point prevalence.

RESULTS

The search identified 40 separate populations from which 46 were included in the analyses, as some studies included samples from multiple countries. The pooled prevalence of suicidal ideation was 17.4% (confidence interval [95% CI], 12.4%-23.9%) for lifetime, 9.33% (95% CI, 7.2%-12%) for the past year, and 4.8% (95% CI, 3.6%-6.4%) for the present time. The pooled prevalence of suicide plans was 9% (95% CI, 6.2%-12.9%) for lifetime, 7.3% (95% CI, 5.1%-10.3%) for the past year, and 2.3% (95% CI, 0.8%-6.7%) for the present time. The pooled prevalence of suicide attempts was 5.2% (95% CI, 3.5%-7.8%) for lifetime and 4.5% (95% CI, 3.4%-5.8%) for the past year. Higher rates of suicide attempts in the lifetime were noted in Nepal (10%) and Bangladesh (9%), while lower rates were reported in India (4%) and Indonesia (5%).

CONCLUSIONS

Suicidal behaviors are a common phenomenon among students in the SEA region. These findings call for integrated, multisectoral efforts to prevent suicidal behaviors in this group.

Self-harm in university students: A comparative analysis of data from the Multicentre Study of Self-harm in England

BACKGROUND

Increases in poor mental health and suicide have been identified among university students in the UK. However, little is known about self-harm in this group.

AIMS

To describe and identify care needs of university aged-students who self-harm via comparisons with an age-equivalent non-student group who self-harm.

METHODS

Observational cohort data from The Multicentre Study of Self-harm in England were used to investigate students aged 18 to 24 years who presented to emergency departments for self-harm, 2003 to 2016. Data were collected via clinician reports and medical records from five hospitals in three English regions. Characteristics, rates, repetition, and mortality outcomes were investigated.

RESULTS

The student sample included 3491 individuals (983, 28.2 % men; 2507, 71.8 % women; 1 unknown) compared to 7807 (3342, 42.8 % men; 4465, 57.2 % women) non-students. Self-harm increased over time in students (IRR 1.08, 95%CI 1.06-1.10, p < 0.01) but not in non-students (IRR 1.01, 95%CI 1.00-1.02, p = 0.15). There were differences in monthly distribution of self-harm with more presentations by students in October, November, and February. Characteristics were broadly similar, but students reported more problems with studying and mental health. Repetition (HR 0.78, 95%CI 0.71-0.86, p < 0.01) and mortality (HR 0.51, 95%CI 0.33-0.80, p < 0.01) were lower in students than non-students.

CONCLUSIONS

Self-harm in students may be directly related the student experience, such as academic pressure, relocation, and the transition to independent living. Wellbeing initiatives targeting these factors, alongside mental health awareness training for academic and non-academic staff may help to support students at risk.

Notifying university students' emergency contacts in mental health emergencies: Multi-year analysis of student consent policy preferences

Information sharing is a frequently discussed yet divisive suicide prevention strategy in universities. This study aimed to investigate which students are most and least likely to opt-in to university permission to notify an emergency contact if there are serious concerns about their mental health. Routine cross-sectional data were obtained from 29,799 students in 2020 and 31,998 students in 2021 within a UK university. The proportion of students opting-in to a 'consent to contact policy' across years was summarised descriptively. Multiple logistic regression models examined the odds of students opting-in dependent on student characteristics (probable clinical depression, age, gender identity, sexuality, ethnicity, home/international student status, disability, study mode and level of study). Most students opted-in to the policy in 2020 (91.2%, n = 27,146) and 2021 (90.4%, n = 28,912). Probable clinical depression (OR = 0.63, 95% CI = 0.54 to 0.72) and gender identity different from sex (OR = 0.63, 95% CI = 0.44 to 0.90) had the strongest associations with not opting-in in 2020. Identifying as male, lesbian/gay/bisexual, Asian ethnicity, declaring a disability, and being a taught postgraduate student were also predictive of not opting-in. These results were replicated in the 2021 dataset. Some of the most vulnerable students appear least likely to opt-in. Insights are offered about potential gaps in universities' access to emergency contacts to prevent serious harm or loss of life. Further research is required into why the groups identified in this study are less likely to opt-in and what additional support they may require.

The Mental Imagery for Suicidality in Students Trial (MISST): study protocol for a feasibility randomised controlled trial of broad-minded affective coping (BMAC) plus risk assessment and signposting versus risk assessment and signposting alone

BACKGROUND

Going to university is an important milestone in many people's lives. It can also be a time of significant challenge and stress. There are growing concerns about mental health amongst student populations including suicide risk. Student mental health and counselling services have the potential to prevent suicide, but evidence-based therapies are required that fit these service contexts. The Broad-Minded Affective Coping intervention (BMAC) is a brief (6 sessions), positive imagery-based intervention that aims to enhance students access to past positive experiences and associated emotions and cognitions. Pilot data provides preliminary support for the BMAC for students struggling with suicidal thoughts and behaviours, but this intervention has not yet been evaluated in the context of a randomised controlled trial (RCT). The Mental Imagery for Suicidality in Students Trial (MISST) is a feasibility RCT that aims to determine the acceptability and feasibility of evaluating the BMAC as an intervention for university students at risk of suicide within a larger efficacy trial. Key feasibility uncertainties have been identified relating to recruitment, retention, and missing data. Intervention acceptability and safety will also be evaluated.

METHOD

MISST is a feasibility randomised controlled trial design, with 1:1 allocation to risk assessment and signposting plus BMAC or risk assessment and signposting alone. Participants will be university students who self-report experiences of suicidal ideation or behaviour in the past 3 months. Assessments take place at baseline, 8, 16, and 24 weeks. The target sample size is 66 participants. A subset of up to 20 participants will be invited to take part in semi-structured qualitative interviews to obtain further data concerning the acceptability of the intervention.

DISCUSSION

The BMAC intervention may provide an effective, brief talking therapy to help university students struggling with suicidal thoughts that could be readily implemented into university student counselling services. Depending on the results of MISST, the next step would be to undertake a larger-scale efficacy trial.

TRIAL REGISTRATION

The trial was preregistered (17 December 2021) on ISRCTN (ISRCTN13621293) and ClinicalTrials.gov (NCT05296538).

Prediction of suicidal ideation among Chinese college students based on radial basis function neural network

Background

Suicide is one of the leading causes of death for college students. The predictors of suicidal ideation among college students are inconsistent and few studies have systematically investigated psychological symptoms of college students to predict suicide. Therefore, this study aims to develop a suicidal ideation prediction model and explore important predictors of suicidal ideation among college students in China.

Methods

We recruited 1,500 college students of Sichuan University and followed up for 4 years. Demographic information, behavioral and psychological information of the participants were collected using computer-based questionnaires. The Radial Basis Function Neural Network (RBFNN) method was used to develop three suicidal ideation risk prediction models and to identify important predictive factors for suicidal ideation among college students.

Results

The incidence of suicidal ideation among college students in the last 12 months ranged from 3.00 to 4.07%. The prediction accuracies of all the three models were over 91.7%. The area under curve scores were up to 0.96. Previous suicidal ideation and poor subjective sleep quality were the most robust predictors. Poor self-rated mental health has also been identified to be an important predictor. Paranoid symptom, internet addiction, poor self-rated physical health, poor self-rated overall health, emotional abuse, low average annual household income per person and heavy study pressure were potential predictors for suicidal ideation.

Conclusions

The study suggested that the RBFNN method was accurate in predicting suicidal ideation. And students who have ever had previous suicidal ideation and poor sleep quality should be paid consistent attention to.

Feasibility, acceptability and costs of nurse-led Alpha-Stim cranial electrostimulation to treat anxiety and depression in university students

Background

Only a relatively low proportion of university students seek help for anxiety and depression disorders, partly because they dislike current drug and psychological treatment options and would prefer home-based care. The aim of this study is to determine the feasibility, acceptability and cost utility of Alpha-Stim cranial electrostimulation (CES) delivered through a nurse led primary care clinic as a daily treatment for anxiety and depression symptoms by the student at home in contrast to usual primary care.

Method

Feasibility and acceptability of a nurse led clinic offering Alpha-Stim CES in terms of the take up and completion of the six-week course of Alpha-Stim CES. Change in score on the GAD-7 and PHQ-9 as measures of anxiety and depression symptoms at baseline and at 8 weeks following a course of Alpha-Stim CES. Similar evaluation in a non-randomised control group attending a family doctor over the same period. Cost-utility analysis of the nurse led Alpha-Stim CES and family doctor pathways with participants failing to improve following further NICE Guideline clinical care (facilitated self-help and cognitive behaviour therapy).

Results

Of 47 students (mean age 22.1, years, 79% female opting for Alpha-Stim CES at the nurse-led clinic 46 (97.9%) completed a 6-week daily course. Forty-seven (47) students comprised a comparison group receiving usual family doctor care. Both Alpha-Stim CES and usual family doctor care were associated with large effect size reductions in GAD-7 and PHQ-9 scores from baseline to 8 weeks. There were no adverse effects and only one participant showed a clinically important deterioration in the Alpha-Stim group. In the cost utility analysis, Alpha-Stim CES was a cheaper option than usual family doctor care under all deterministic or probabilistic assumptions.

Conclusion

Nurse delivered Alpha-Stim CES may be a feasible, acceptable and cheaper way of providing greater choice and home-based care for some university students seeking help from primary care with new presentations of anxiety and depression.

Web-based support services to help prevent suicide in young people and students: A mixed-methods, user-informed review of characteristics and effective elements

The online world may provide an alternative means to engage young people and students with suicidal feelings, who are typically reluctant to seek help. We aimed to map, characterise and obtain user evaluation of current online suicide support for this group in order to assess the usefulness of current provision and how it may be improved. We conducted a mixed-methods study, comprised of an internet search, content analysis of site features and qualitative interviews with site users: 9 young people and 4 general practitioners. Data collection took place in 2019 and 2020 in the UK. Young people participants were recruited through the well-being networks of a large University in South-West England and via a national young person's mental health app. General practitioners were recruited locally through professional networks. We identified a wide range of easily accessible online support, including examples of interactive services, such as live chat and text messaging, but a lack of support that is both suicide-specific and young adult-specific, and an absence of online suicide or mental health crisis support services tailored specifically for students. Qualitative data showed that clarity, brevity and immediacy are the most important facets of engaging crisis help for young people, and that young people may prefer to use text-based rather than verbal forms of communication when seeking help. Few services provided access to active peer support, outside of lived-experience stories, which were evaluated as both valuable and potentially harmful. There is a need to further develop tailored suicide specific online crisis support for young people and students, which is able to 'speak to' their age-specific needs and preferences. While lived experience may provide a valuable means of supporting young audiences, caution is required since this may have unintended negative consequences and further research is needed to understand the safe framing of such material.

Content analysis of reports of student suicide deaths in South African print medium newspapers

Purpose

The aim was to assess the quality of newspaper reporting of university student suicides in South Africa, using the World Health Organisation guidelines. Suicide among university students is a growing public health problem. The media has an important role to play in preventing student suicides by adhering to international best practice guidelines on ethical reporting of suicides.

Design/methodology/approach

This study conducted a content analysis of print medium newspaper articles in the 13 most widely read English language South African newspapers from the period of January 2017 to January 2020.

Findings

The initial search yielded a total of 28 news reports, of which 19 met this study’s inclusion criteria and were analysed using content analysis. The quality of reporting showed both potentially harmful and helpful characteristics. Poor adherence to international reporting guidelines were found in the description of method and location of suicide, sensational headlines, publishing photos of the deceased, linking suicide to criminality, simplistic narration of the life events leading to the suicide and use of sensational and potentially triggering language. No reports adhered to all reporting guidelines. Findings suggests that there are widespread potentially unhelpful practices in the reporting of student suicides and a need for suicide prevention experts to work with journalists to promote critical reflexivity and ethical reasoning when writing about student suicides.

Research limitations/implications

This study only included news reports published in English in the most widely read newspapers.

Originality/value

To the best of the authors’ knowledge, this is the first study of its kind to systematically examine media reporting on suicide in South Africa.

Mental health and mental well-being of Black students at UK universities: a review and thematic synthesis

BACKGROUND

There is a knowledge gap about the experiences that affect the mental health of Black university students in the UK. Current research is focused on understanding the continuation, attainment and progression gap between Black students and non-Black students. It is essential to know more about the interactions between personal and institutional factors on the mental health of Black students to explain the inequalities in their experiences and outcomes across the university lifecycle. The current study set out to thematically synthesise articles that explore the experiences that affect the mental health and mental well-being of Black university students in the UK.

METHODS

This study is a qualitative thematic synthesis of a literature review. We developed search strategies for four online databases (PubMed, Social Science Premium Collection via ProQuest, Open Access Theses and Dissertations, and Open Grey) covering January 2010 to July 2020. This search was combined with a manual search of reference lists and related citations. All articles in English addressing mental health and mental well-being experiences among Black university students studying at a UK university were included. Critical Appraisal Skills Programme Checklist was used to assess bias. A thematic synthesis was conducted using Braun and Clarke (2006)'s six-step guide to develop descriptive themes and analytical constructs.

RESULTS

Twelve articles were included. Several themes were identified as affecting the mental health of Black university students in the UK: academic pressure, learning environment, Black gendered experience, isolation and alienation, culture shock, racism and support.

DISCUSSION

This review provides an appraisal of the factors affecting the mental health and mental well-being of Black students at UK universities, which need to be addressed by higher education policy-makers and key decision-makers. Further research is needed about the mental health experiences of Black university students in relation to Black identities, suicidality, mental health language, the physical environment, and racism and other institutional factors.

A positive mental imagery intervention for targeting suicidal ideation in university students: A pilot study

Objectives

Suicide is a major public health concern and is now considered to be the leading cause of death in young people. Suicidal ideation within student populations has recently increased. The Broad‐Minded Affective Coping (BMAC) offers a brief psychological intervention targeting suicidal ideation by enabling access to competing positive emotions and thoughts using guided imagery. Its acceptability and feasibility in student populations are unclear.

Design

A single arm pilot study investigated the feasibility and acceptability of a six‐session BMAC intervention for university students experiencing suicidal ideation.

Method

Recruitment took place from university counselling services. Suicidal ideation and emotional states were assessed at baseline and after 6 and 12 weeks. Participants also completed corresponding sessional measures.

Results

Twelve eligible participants consented to take part with 11 receiving the intervention. Ten participants completed post treatment and follow up assessments. Retention to treatment was high with participants attending an average of 5.2 (87%; SD = 1.54) out of six intervention sessions. There were also good completion rates of the BMAC technique between sessions. Participants reported high levels of satisfaction with the intervention. There was an associated reduction across a range of clinical outcomes, including suicidal ideation, with large effect sizes.

Discussion

This pilot study showed promising results on the feasibility and acceptability of the BMAC intervention in students experiencing suicidal ideation. However, the study had a small sample size and no comparator control group. Further exploration of the BMAC intervention is warranted.

The Association Between Personality Disorder Traits and Suicidality Following Sudden Bereavement: A National Cross-Sectional Survey

Personality disorder is associated with increased risk of suicidal behavior. The authors aimed to investigate the association between number of personality disorder traits and suicidality risk following sudden bereavement. A secondary analysis of cross-sectional data on 3,167 young adults in the United Kingdom who had experienced sudden bereavement investigated the association between number of traits (measured using a standardized screening instrument) and postbereavement suicide attempt and suicidal ideation. Using multivariable logistic regression, the authors found a linear relationship between number of traits and suicide attempt (adjusted odds ratio [AOR] = 1.36, 95% CI [1.23, 1.49]) and suicidal ideation (AOR = 1.31, 95% CI [1.25, 1.38]) following bereavement. This represented an increase in odds by 36% and 31%, respectively, for each additional personality trait. The authors suggest that individuals with a greater number of traits suggestive of a personality disorder diagnosis are at increased risk of suicidality after a negative life event.

Factors Associated with Mental Health among International Students during the COVID-19 Pandemic in South Korea

The purpose of this study was to investigate mental health problems among international students in South Korean universities during the COVID-19 pandemic, as well as to identify the factors that affect their mental health. A total of 488 international students living in South Korea participated in a web-based survey. The questionnaire was created using the Google Forms platform, and a link to the questionnaire was shared through social media. Multiple logistic regression analysis was conducted to analyze the data. The prevalence rates of sleep problems, anxiety, and depression among international students were 47.1%, 39.6%, and 49%, respectively. The prevalence of mental health problems was higher among participants who were male, living with someone, residents of a rural area, and earning a higher income. The following variables were found to contribute to the prevalence of mental health problems: undergraduate student status, good understanding of the Korean language, longer hours of media usage, and experiences related to COVID-19 infection. A collaborative effort between the government and universities to manage the mental health of international students could promote the mental health of these students.

Exploration of Mental Health Issues of Students among University Health Science Academics in Japan

Academic educators in universities are well positioned to detect early signs and symptoms of unexplained behaviour change in students that could be the beginning of mental health issues. The purpose of this research was to explore the attitudes, beliefs, knowledge and practices of university academics in Japan towards health science students with psychological/mental health issues. This study used a qualitative descriptive design. Three focus groups using a semi-structured interview guide were conducted with 15 academics teaching health science students. Data were collected between March to October 2019. Themes revealed three areas of interest: 1) Reflection on mental health issues in Japan with sub-themes "family issues"; "society expectations and changes", and "stigma"; 2) Reflection on students' mental health issues with sub-themes "student behaviors", "staff involvement", "barriers encountered"; and, 3) Potential supports with sub-themes "university assistance", "communication and connection", and "interventions and prevention." The findings provide insight and can benefit student populations across diverse cultural university settings. Further research to investigate academic staff support with early recognition of mental ill-health and ability to provide information and advice to students is warranted. Recommendations include mental health education for academics and for students to encourage healthy university campuses and well-being within the community.

Intervention effect of cognitive behaviour therapy under suicidology on psychological stress and emotional depression of college students

BACKGROUND

The suicide of college students had been a social topic attracting people's attention, and the generation of suicidal ideation was an inevitable link in the psychological process of suicidal behavior. It was the focus of many researches whether the pressure of college students with suicidal ideation can be detected and relieved in time.

OBJECTIVE

The study aimed to analyze the therapeutic effect of cognitive behaviour therapy on psychological stress, depression, and other negative emotions of college students with suicide ideation.

METHODS

114 people from 1,158 college students with suicide ideation in the Wuhan area were divided into an experimental group and a control group in this study. Students in the experimental group were given with the cognitive behaviour therapy, and students in the control group were not intervened in any way. The suicide ideation scale (despair, optimism, and sleep), psychological stress test rating, and self-reporting inventory (somatization, compulsion, interpersonal relationship, depression, anxiety, hostility, terror, delusion, and psychosis) were used to evaluate the objects in the pre-test stage, intermediate-test stage, and the tracking-test stage. The multivariate logistic regression was adopted to analyze the influencing factors of the suicide ideation of the college student.

RESULTS

The suicide ideation of the college student was significantly positively correlated with the psychological stress, depression, interpersonal sensitivity, anxiety, and psychosis (P > 0.05); the total score of suicide ideation, despair, optimism, and sleep in the experimental group were lower than those in the control group (P < 0.05) in the intermediate-test stage and the tracking-test stage (P < 0.05); the psychological stress, depression, and anxiety of the college students in the experimental group in the intermediate-test and tracking-test stage were slighter than those in the control group (P < 0.05); the somatization, compulsion, and interpersonal relationship of students in the experimental group were significantly lower than those in the control group (P < 0.05).

CONCLUSIONS

The psychological stress, depression, interpersonal sensitivity, anxiety, and psychosis were all risk factors for the college student to have suicide ideation. Negative emotions such as psychological stress, emotional depression, and anxiety of the college student with suicide ideation could be improved effectively by cognitive behaviour therapy, and the level of suicide ideation could be reduced finally.

Prevalence and risk factors for mental health problems in university undergraduate students: A systematic review with meta-analysis

BACKGROUND

Effective targeting of services requires that we establish which undergraduates are at increased risk of mental health problems at university. We aimed to conduct a systematic review and meta-analysis of the prevalence and risk factors for mental health problems in undergraduates.

METHODS

We searched MEDLINE, PsycInfo, EMBASE and the Cochrane Central Register. Eligible studies were assessed using the Quality of Prognostic Studies checklist and narratively synthesised. Pooled prevalence of depression and suicide-related outcomes, and associated risk factors (odds ratios) were estimated using random-effects meta-analyses.

RESULTS

Sixty-six eligible studies of varying quality were included in a narrative synthesis. The pooled prevalence of depression (eight studies; 13,790 participants) was 25% (95% CI 17%, 35%) and the pooled prevalence of suicide-related outcomes (four studies; 2,586 participants) was 14% (95% CI 0%, 44%). Thirteen studies contributed to meta-analytic syntheses of 12 depression-related and four suicide-related risk factors. Presenting with a current mental health problem, negative rumination, parent separation, experiences of sexual harassment and parental depression significantly predicted depression outcomes. Childhood adversity, baseline mental health problems and financial difficulties significantly predicted suicide-related outcomes.

LIMITATIONS

Student mental health is a heterogeneous research area and is hampered by the use of imprecise terms, both for describing risk factors and mental health outcomes. These inconsistencies limit the extent to which datasets can be meaningfully synthesised.

CONCLUSIONS

This review evidences the importance of a range of risk factors for poor undergraduate mental health. Interventions should be developed to target modifiable risk factors and prevent poor mental health outcomes. Systematic review registration: PROSPERO registration CRD42019144927.

Bearing witness: A grounded theory of the experiences of staff at two United Kingdom Higher Education Institutions following a student death by suicide

Wider networks of people are affected by a suicide death than originally thought, including those whose job-role brings them into contact with a death by suicide of another person. The impact of student suicide within United Kingdom (UK) Higher Education Institutions (HEIs) is unexplored and the experiences of staff members remain unknown. It is not known whether staff members have specific postvention needs following a student death by suicide. Any postvention support currently offered to staff members within UK HEIs lacks a context-specific evidence base. This study asked 'How is a student suicide experienced by staff members within a UK HEI and what are the features of that experience?' Staff members from diverse job-roles in two UK HEIs responded to a qualitative survey (n = 19) and participated in semi-structured interviews (n = 10). Data were transcribed and subjected to a constructivist grounded theory analysis. Participants' experiences informed the development of a core category: 'Bearing witness', which encompassed six further categories: 'Responding to a student suicide'; 'Experiencing a student suicide'; 'Needs and fears'; 'Experiences of support'; 'Human stories'; and 'Cultural stories'. The resulting grounded theory demonstrates how participants' perceptions of impact are informed by their experiences of undertaking tasks following a student suicide within the community of their HEI. Processes of constructing perceptions of closeness to the student who died are evident amongst participants who did not know the student prior to their death. Tailored postvention support is required to respond to the range and complexity of HEI staff needs following a student death by suicide.

Benefits of a psychoeducational happiness course on university student mental well-being both before and during a COVID-19 lockdown

We tested whether a psychoeducational course improved well-being in three cohorts. Study 1 found significantly higher mental well-being in first year undergraduates who took the course compared to a waiting-list control. Study 2 revealed that students taking the course when COVID-19 restrictions began did not experience increases in mental well-being but had significantly higher well-being than a third matched group. In Study 3, an online course increased mental well-being in University students and staff during a COVID-19 lockdown. These findings support the claim that psychoeducational courses are beneficial in both live and online formats and in times of collective uncertainty.

Accurate Diagnosis of Suicide Ideation/Behavior Using Robust Ensemble Machine Learning: A University Student Population in the Middle East and North Africa (MENA) Region

Suicide is one of the most critical public health concerns in the world and the second cause of death among young people in many countries. However, to date, no study can diagnose suicide ideation/behavior among university students in the Middle East and North Africa (MENA) region using a machine learning approach. Therefore, stability feature selection and stacked ensembled decision trees were employed in this classification problem. A total of 573 university students responded to a battery of questionnaires. Three-fold cross-validation with a variety of performance indices was sued. The proposed diagnostic system had excellent balanced diagnosis accuracy (AUC = 0.90 [CI 95%: 0.86-0.93]) with a high correlation between predicted and observed class labels, fair discriminant power, and excellent class labeling agreement rate. Results showed that 23 items out of all items could accurately diagnose suicide ideation/behavior. These items were psychological problems and how to experience trauma, from the demographic variables, nine items from Post-Traumatic Stress Disorder Checklist (PCL-5), two items from Post Traumatic Growth (PTG), two items from the Patient Health Questionnaire (PHQ), six items from the Positive Mental Health (PMH) questionnaire, and one item related to social support. Such features could be used as a screening tool to identify young adults who are at risk of suicide ideation/behavior.

Suicide Deaths in University Students in a UK City Between 2010 and 2018 - Case Series

Background: There are longstanding concerns over the mental health and suicide risk of university students in the UK and internationally. Aims: This study aimed to identify risk factors for suicide among students attending universities in a UK city. Method: Suicide deaths between January 2010 and July 2018 were identified from university records. An audit tool was used to collate data from university records and coroners' inquest files. Results: A total of 37 student deaths were identified. Only 10.8% of the students had disclosed a mental health issue at university entry. There was strong statistical evidence that students who died by suicide were more likely to have been male, experiencing academic difficulties (repeated years, changing course, and suspension of studies were all associated with a 5-30-fold increased risk), and in need of financial support compared with other students. Limitations: The coroners' records were only available for around half of the deaths. Healthcare records were not available. Conclusion: Markers of academic and financial difficulty should be considered as flags to identify students at heightened risk. Whilst the relative risk associated with academic difficulties is high, the absolute risk is low. Improved disclosure of mental health issues at university registration could facilitate targeted support for vulnerable students.

Predictors of mental health and academic outcomes in first-year university students: Identifying prevention and early-intervention targets

BACKGROUND

Although there is growing interest in mental health problems in university students there is limited understanding of the scope of need and determinants to inform intervention efforts.

AIMS

To longitudinally examine the extent and persistence of mental health symptoms and the importance of psychosocial and lifestyle factors for student mental health and academic outcomes.

METHOD

Undergraduates at a Canadian university were invited to complete electronic surveys at entry and completion of their first year. The baseline survey measured important distal and proximal risk factors and the follow-up assessed mental health and well-being. Surveys were linked to academic grades. Multivariable models of risk factors and mental health and academic outcomes were fit and adjusted for confounders.

RESULTS

In 1530 students surveyed at entry to university 28% and 33% screened positive for clinically significant depressive and anxiety symptoms respectively, which increased to 36% and 39% at the completion of first year. Over the academic year, 14% of students reported suicidal thoughts and 1.6% suicide attempts. Moreover, there was persistence and overlap in these mental health outcomes. Modifiable psychosocial and lifestyle factors at entry were associated with positive screens for mental health outcomes at completion of first year, while anxiety and depressive symptoms were associated with lower grades and university well-being.

CONCLUSIONS

Clinically significant mental health symptoms are common and persistent among first-year university students and have a negative impact on academic performance and well-being. A comprehensive mental health strategy that includes a whole university approach to prevention and targeted early-intervention measures and associated research is justified.

Trends in mental health, non-suicidal self-harm and suicide attempts in 16-24-year old students and non-students in England, 2000-2014

There are concerns about high levels of mental ill-health amongst university students, but little is known about the mental health of students compared to non-students over time. Using data on young people (16-24) from three UK National Psychiatric Morbidity Surveys (2000, 2007, and 2014), we found no evidence that the overall prevalence of common mental disorder (CMD), suicide attempts, or non-suicidal self-harm (NSSH) differed between students and non-students, although there was an indication that CMDs rose markedly in female students between 2007 and 2014. A rise in NSSH is apparent in both students and non-students.